Imaging recommendation · Abdomen · Pelvis

Living liver donor — pre-operative imaging

Q: What's the alternative imaging for living liver donor — pre-operative imaging when biliary anatomy detail?

MRI — MRCP — separate sequence within the MRI (no contrast).

Q: What's the alternative imaging for living liver donor — pre-operative imaging when quantification of steatosis?

MRI — MR proton density fat fraction (PDFF) (no contrast).

Q: What's the alternative imaging for living liver donor — pre-operative imaging when volumetry alternative?

CT — CT volumetry — most centers use this directly from donor CT (iv contrast).

Recommended: Multiphase CT or MRI of the liver (donor protocol) is the preferred imaging study for living liver donor — pre-operative imaging. Comprehensive evaluation: hepatic arterial anatomy (replaced/accessory), portal venous anatomy (trifurcation, accessory vessels), hepatic venous anatomy (accessory right hepatic veins draining segments 5/8 directly to IVC), biliary anatomy (MRCP), liver volumetry (remnant > 30%), and parenchymal characterization (steatosis quantification).

Recommended study

Multiphase CT or MRI of the liver (donor protocol)

CT IV contrast Preferred Abdomen · Pelvis Outpatient Reviewed 2026-05

Comprehensive evaluation: hepatic arterial anatomy (replaced/accessory), portal venous anatomy (trifurcation, accessory vessels), hepatic venous anatomy (accessory right hepatic veins draining segments 5/8 directly to IVC), biliary anatomy (MRCP), liver volumetry (remnant > 30%), and parenchymal characterization (steatosis quantification). Multiphase CT or MRI with hepatobiliary contrast (Eovist) achieves all in one study.

If the default doesn't apply

Biliary anatomy detail

MRI MRCP — separate sequence within the MRI No contrast

Quantification of steatosis

MRI MR proton density fat fraction (PDFF) No contrast

Volumetry alternative

CT CT volumetry — most centers use this directly from donor CT IV contrast

Watch-outs

Replaced / accessory hepatic arteries

Replaced right hepatic from SMA (~15%) or replaced left hepatic from left gastric (~15%) — surgical impact on right or left grafts.

Accessory right hepatic veins draining segments 5/8

Need reconstruction during transplant — missing one causes venous congestion in the graft.

Steatosis > 30%

Excludes donation in most programs — quantify before surgical workup.

Pearls

Standard right lobe graft (segments 5–8): remnant volume must exceed 30% of total liver volume.
Couinaud anatomy + 3D reconstruction is now standard in major transplant centers.
MR proton density fat fraction > 5–6% indicates steatosis; > 30% disqualifies most donors.
Hepatobiliary contrast MRI delineates biliary tree without ERCP.